NIIT ___________________________________________________PPPE.FM.07 PP CONVERSION FORM

1. Name of the Student _______________________________ 2. Registration No. _______________________________ 3. Student_id _______________________________ 4. Name of the Organization where PP is to be converted _______________________________ 5. Full address of the Organization _______________________________ 6. Telephone No: _______________________________ 7. Fax No.: _______________________________ 8. Site Address _______________________________ 9. Telephone/Mobile No.: _______________________________ 10. Names and Designation of the Mentor ______________________________ 11. Telephone/Mobile No. ______________________________ 12. Email _______________________________ 13. Nature of Assignment during PP _______________________________ 14. Monthly Stipend during PP _______________________________ 15. Date of Starting PP _______________________________ 16. Material given to the Student _______________________________

(To be filled in by the Student) As per the requirements I agree to convert my job with the above Organization as my PP, starting on ______________ (has to be a date after the conversion is approved). (To be filled in by the IC) I understand that the organization where PP is being converted is appropriate and they have agreed to:

1. Abide by the rules of Professional Practice 2. Abide by period of 1 year of PP without break 3. To allot a mentor for the student 4. Issue Acceptance Letter for the Student to commence PP

Student’s ‘ Signature & Date CGE Signature & Date IC head’s Signature & Date